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Disordered Eating
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This is the final module of Information Pack B, which provides information and strategies to help you start changing the thoughts associated with your disordered eating and weight control habits. We recommend that you do not proceed with this Information Pack unless you have worked through Information Pack A, which offers strategies to change your disordered behaviours. We also recommend that you work through all the modules in this Information Pack in order. If you do think you might suffer from an eating disorder, it is important that you talk to your General Practitioner, as there are many physical complications that can arise from being at an unhealthily low weight or from losing weight very quickly, or from purging. We advise you to seek professional help with working on an eating disorder. If you use any extreme weight control behaviours even rarely you should also see your General Practitioner for a full medical check-up, as your health might be compromised. Such extreme measures include: extreme food restriction/fasting (and/or rapid weight loss) purging (self-induced vomiting, misuse of laxatives or diuretics) extreme exercise
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Introduction
Congratulations on making it to the end of this Information Package! In this Information Pack B we have described unhelpful thoughts and thinking styles, and offered you strategies to change the thoughts that maintain disturbed eating and weight control methods. If you havent read all the modules of Information Packs A and B, it might be good to go back to the ones you missed. If you have worked your way through the modules, you will have learnt the facts about your disordered eating and the skills you need to overcome it. It is unlikely that you will have overcome all your disturbed eating and weight control behaviours, and thats OK - you can continue to work on changing. If you have just read through the modules without engaging in change, that is fine. When you are ready to commit to changing your disturbed eating and weight control behaviours, you can go back to the beginning and work through the modules, or you might choose to seek professional help. In this final module of Information Pack B we will devise a plan for maintaining the positive behavioural and cognitive changes that you have already achieved. We will also examine relapse prevention in the long term. You will find a summary of all the concepts and strategies that were introduced in the previous modules.
Maintenance Plan
To maintain the changes that you have already achieved, you will need to devise a personal maintenance plan. Making changes is not enough you need to continue your progress and maintain those gains. A plan is useful to help you stay on track. To make your plan, you will need to review your progress to date and identify what problems you still have. You will then need to identify what has been particularly useful to you in helping you overcome your disturbed eating habits and weight control behaviours. Finally, it will be beneficial to identify positive habits that will help you to maintain the changes you have made. Reviewing Progress Now is the time to review the progress that you have achieved. You will need to conduct a thorough review, as you did at the end of Information Pack A. Remember, to make changes you need to be aware of what is going on, so it is important to be clear about what is going well and what is still a challenge. Initially, you implemented behavioural change through self-monitoring and regular eating. As you progressed through the two Information Packs, you addressed binge eating; compensatory behaviour such as purging (vomiting and/or laxative, diuretic misuse) and driven exercise; strict dietary rules (about when, what and how much to eat); preoccupation with food, eating, weight, shape and control; feeling fat; fear of weight gain; weight and shape checking (and avoidance); low self-esteem; and the eating disorder mindset. You may now find it helpful to identify the areas in which you have made positive changes. Changes you have achieved may include removing dietary rules, learning to eat regularly, ceasing driven exercise, limiting body checking, or bringing an end to binge eating. When you identify your progress, congratulate yourself! You should feel proud of the changes you have made so far. Inevitably there will be areas in which your progress is limited. Remember that changing long-established habits is a difficult task, so dont beat yourself up for not being completely over your disordered eating. Just because you have almost reached the end of this Information Pack, it doesnt mean that this is as far as you will go with overcoming your disturbed eating habits and weight control behaviours. There is every chance that, if you apply yourself and use the techniques and worksheets introduced in the earlier modules, you will be able to continue your progress. To gain more information about your progress in overcoming your disordered eating, complete the Progress Checklist overleaf.
for Centrelinical C Interventions
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Progress Checklist
Please rate yourself on how much these issues are present for you (over the past week): No problem Physical health Being underweight (BMI under 19) Menstruation (irregular/absent) Other physical complications Disturbed eating habits and weight control behaviours Binge eating Vomiting Misuse of laxatives/diuretics Over-exercising Irregular eating (when) Low variety of foods (what) Undereating (how much) Preoccupation with food/eating Preoccupation with shape/ weight & its control Feeling fat Fear of gaining weight or getting fat Frequent weighing or avoidance Body shape checking or avoidance A little Moderate A lot Extreme
Positive Change Look over the Progress Checklist and consider your progress. What changes have you already made? Do you eat regularly? Have you changed your eating habits? Have you stopped binge eating or purging? Are you following guidelines instead of strict dietary rules? What are the behaviours or thoughts that cause you little or no problem? Take some time to identify the positive changes that you have made, and list them.
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Remaining Challenges Now it is time to identify remaining problem behaviours. This does not mean that you have failed. Changing ingrained habits is a difficult process and takes time. Identifying your problem behaviours will help you direct attention to areas that need more work. What behaviours are still challenging? What areas did you identify as a lot or extreme problems and need more work? Identify your problem areas and list them.
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My Maintenance Plan
Healthy weight My healthy weight range is between _____________ and ______________ kg. I need to work hard to accept this weight range as a healthy, realistic weight range for me. I need to continue to work towards attaining and sustaining a weight within this range. Techniques and strategies that Ive found useful and that I would like to keep using: Useful techniques/strategies Which Information Pack & module was it in? What page?
Good habits the thoughts and behaviours Ive found helpful and want to maintain:
Healthy eating habits the healthy eating patterns Ive adopted and want to keep up:
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Combating Warning Signs Now that you have thought about your early warning signs, you can devise a plan for dealing with them. Firstly, you need to identify the points at which you will need to act. Have a clear understanding of your early warning signs. When you have it clear in your mind that you will need to act if a certain thought or behaviour appears, you will not let your early warning signs go unheeded. Secondly, once you identify the need to act, do it immediately. Do not wait for your warning sign to develop into problem behaviour. It is easier to combat a warning sign early than to deal with a return to disordered eating habits. Thirdly, have a plan to combat your early warning signs that is specific to your needs. Developing a plan to combat your warning signs is a personal task. Use the skills you have developed throughout these modules to combat your early warning signs. Is your warning sign a thought? If it is, critically examine your thought. Where is it coming from? Is it reasonable? Logical? Alternatively, is your warning sign a behaviour? If so, critically examine this behaviour. Why are you doing it? Do you need to do it? Does it make you feel better or worse? What are the consequences? Use the answers to these questions to combat the thought or behaviour. As you develop plans to combat your warning signs, use the problem solving strategy we examined in Module 9 of Information Pack A. Finally, you may find it useful to re-examine any relative modules to find a strategy that works for you. What will you do to combat your early warning signs? Develop your plan for dealing with these thoughts and behaviours.
Dealing with Setbacks It is likely that you will experience occasional setbacks after finishing these modules. However, it is important to view a setback as a lapse, not a relapse. Just because you make one mistake doesnt mean you have relapsed to your old pattern of disturbed eating or weight control behaviours. Instead, view a lapse as an interesting phenomenon to be understood. Take a helicopter view take a step back from your behaviour, and examine it critically. Examine your lapse as if you were watching someone else. What led to the lapse? How might you deal with it better in the future? What steps do you need to take to get back on track? In this way, you are using a lapse as an opportunity to learn from your mistakes. Take some time to consider how you would deal with a setback. What would you do? How would you handle the situation?
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Thought? Behaviour?
behaviour
Challenge it!
I know that skipping meals makes me more likely to binge
Develop a plan
Keep to regular eating, even though Ill be eating more at Xmas
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Module Summary
This is the last module in Information Pack B, which has provided strategies to change the thoughts associated with disturbed eating and weight control measures. Your progress review should help you identify positive changes and remaining problem behaviours that require more attention. To help you maintain your changes after completing this Information Package, you will need to review your progress and develop both a maintenance plan and a relapse prevention plan. Your maintenance plan should include a list of useful techniques you have learned from working through the modules; a list of good habits that have helped you achieve progress and that you would like to continue in the future; and a list of healthy eating habits you have developed and want to keep up. Your relapse prevention plan should include: times of high risk, early warning signs; combating warning signs; and dealing with setbacks. Dont view a lapse as relapse. Use setbacks as an opportunity to learn from your mistakes. You need to have realistic expectations about life after completing the modules. You will always need to be watchful for signs of old habits creeping back. A summary of each module in this Information Pack is provided to give an overview.
Think about how you might use the information you have just learned. Write down some ways in which you could make use of this information.
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Paula Nathan (M.Psych.3) Director, Centre for Clinical Interventions Adjunct Senior Lecturer, School of Psychiatry and Clinical Neuroscience, University of Western Australia Amy Lampard (B.A. Hons4) MPsych (Clinical)/ PhD Candidate University of Western Australia
2 Doctor
4 Bachelor
We would also like to thank Karina Allen for her contributions to the presentation of these Information Packs. BACKGROUND AND REFERENCES The concepts and strategies in this module have been developed from evidence-based psychological treatment of eating disorders, primarily Cognitive Behaviour Therapy (CBT). This can be found in the following: Fairburn, C. G. (1995) Overcoming Binge Eating. New York: The Guilford Press Fairburn, C. G., Cooper, Z., & Shafran, R. (2003) Cognitive behaviour therapy for eating disorders: a transdiagnostic theory and treatment. Behaviour Research and Therapy 41, pp 509-528 Fairburn, C. G. (2008) Cognitive Behavior Therapy and Eating Disorders. New York: The Guilford Press
OVERCOMING DISORDERED EATING This module forms part of: Fursland, A., Byrne, S. & Nathan, P. (2007) Overcoming Disordered Eating. Perth, Western Australia: Centre for Clinical Interventions ISBN: 0-975799533 Created: March 2007. Revised November 2010.
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